I am an emergency physician on staff at Lenox Hill Hospital in New York City, where I have practiced for the past 10 years. I also serve as an adviser to Medscape Emergency Medicine, an educational portal for physicians, and an affiliate of WebMD. My other time is spent with my private house call practice called DR 911, providing medical care to both travelers and residents in Manhattan. I have a keen interest in medical technology and public health education.

Cyclospora Outbreak: What You Need To Know

The cyclospora outbreak in the US which began in mid June has now affected 285 people in 11 states. The CDC still does not know the exact source of the parasite which has hospitalized 18 people thus far. The CDC has only verified the parasite in fecal samples from 5 people to date.

Over 125 cases have been identified in Iowa. There is no clear history of an originating source based on travel history thus far. According to a report this week from the Iowa Dept of Public Health, the source may be more likely originating from fresh vegetables as opposed to fruit.

Cyclospora is a one-celled parasite which is too small to be seen by the human eye. It causes explosive watery diarrhea, as well as nausea and vomiting. Other common symptoms include fatigue, muscle aches, low grade fever, and loss of appetite.

Cyclospora outbreaks originate from contaminated food or water, often in tropical or subtropical climates. Outbreaks that have occurred in the US in the past have generally have been linked to imported fresh produce.

Raspberries, basil, lettuce, snow peas have been sources of previous outbreaks since the 1990s.

Often times, in healthy persons, the illness is self- limited, and resolves with supportive care including fluids, and medicine for nausea if vomiting develops. The illness can last as little as 2-7 days–but can linger for several weeks to sometimes months in some cases.

The onset can be as soon as 1 day but up to 2 weeks after exposure to the parasite. It may not be uncommon to develop relapses associated with this parasite.

When patients appear ill or dehydrated, intravenous fluids may be necessary to restore fluid volume and electrolytes.

Diagnosis can be made by detecting the parasite in stool specimens, specifically by identifying oocytes. There are currently no blood tests that can detect antibodies to Cyclospora.

The Polymerase Chain Reaction (PCR) test can detect Cyclospora DNA in stool specimens. It is commercially available, and is likely the most acccurate method to make the diagnosis.

Antibiotics which can be used to treat the infection include Septra or Bactrim. Cipro can also be used in patients with a sulfa allergy–however, this may not be optimal therapy.

Antibiotics may help to reduce symptoms and also improve the time to recovery for those with prolonged symptoms as well as loss of appetite. In most cases, appropriate antibiotics can stop the diarrhea within 2 days.

It is unclear what the source of contamination is at this time-the produce itself, or related to contaminated irrigation systems involved in farm settings.

The CDC is recommending that people be careful by taking precautions to wash any fresh fruits and vegetables thoroughly until we know the food source that is causing the outbreak.

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